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Preventive Care is
important to your health

Health Benefits & Coverage

What is Preventive Care?

Preventive care (sometimes called “preventative care”) is routine health care that includes screenings, services and counseling to help prevent illness, disease or other health problems. It’s covered by your plan because it can help you stay healthy and lets you know if you may develop a health problem.

Don’t let disease sneak up on you. Preventive care could save your life.

Understanding Your Preventive Care Benefits

As mentioned in your benefits booklet, many screenings and tests are covered at 100% with no out-of-pocket costs to you as part of your health plan. Use your preventive care and stop health problems before they get serious.

  Summary of Preventive Care Services

Which Types of Services Are Covered at 100%?

Preventive care that is 100% covered includes many important services like the ones listed below. This list is not complete, so please see the full list of preventive care services and any limitations on the Men, Women and Children pages.

  • Screenings and tests
    • Cancer screenings, such as colon, breast, and cervical
    • Blood pressure
    • Cholesterol
    • Diabetes
  • Well-baby and well-child visits
  • Counseling and support
    • Nutrition
    • Tobacco cessation
    • Alcohol misuse
    • Sexually transmitted infections
  • Immunizations, like the flu shot

View 100% Covered Services for:

Important

To be covered with no out-of-pocket costs, the service must be:

  • At an in-network doctor or facility (urgent care facility, outpatient clinic or ambulatory surgery center)
  • Filed by your doctor as a preventive care visit
  • Identified as preventive care under the Affordable Care Act (ACA)
Find an in-network doctor for preventive care

What Else Do I Need to Know?

Below are examples of common services your doctor may do that are not identified as preventive care by the ACA so are not 100% covered. These services may cost you money at your doctor's office or lab:

  • Urinalysis
  • Hormone tests
  • Vitamin D tests
  • Chest X-rays
  • Thyroid tests
  • EKGs (electrocardiograms)

*NOTE: You should feel free to ask questions about your health. However, tell your doctor that you are there for a preventive care visit and check that your question is about preventive care before talking to your doctor about any medical problem you are having. If your question is not about preventive care, your doctor may file the visit as diagnostic (and not preventive), which may cost you money.

Download a summary of common screenings plus questions you may want to ask your doctor.

  Download Summary

Sometimes you go to the doctor for preventive care and end up with a charge on your bill. You can avoid costs when you go to your appointment by following these steps:

  1. When you schedule your appointment, say that you want preventive care screenings and tests that are 100% covered by your plan.
  2. Ask if any tests or treatments done during your appointment might not be considered preventive care.
  3. Ask if talking about other health problems that are not considered preventive care during your appointment will lead to extra costs.
  4. Ask if lab work can be sent to a Blue Cross NC in-network lab to lower your costs.

Get a printable summary of common screenings that includes these questions.

 Download Summary

The Affordable Care Act (ACA) has identified certain services as preventive care to be paid at 100%.

  • These benefits are available for members of non-grandfathered individual health insurance plans.
  • If you get benefits from your employer, you may also have these benefits. If your Summary of Benefits section of your benefit booklet contains PREVENTIVE CARE covered under federal law, then you have these benefits at no charge IN-NETWORK.
  • These benefits are currently in effect unless otherwise noted.
  • Check your Benet Booklet for details on other preventive care benefits.
  • This information is a reference tool and does not guarantee payment of any claims
  • For transgendered individuals, you have access to medically appropriate preventive services

Still have questions?

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